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A 34-year-old man presented with mild fatigue and elevated ALT 270 IU/L and AST 154 IU/L, but normal alkaline phosphatase, GGT and bilirubin levels. Additional tests showed hepatitis B virus (HBV) and hepatitis D virus (HDV) infection: positive HBsAg, positive anti-HBc, negative anti-HBs, negative HBeAg, positive anti-HBe and positive anti-HDV.

Which of the following statements is correct about his prognosis and the natural history of HBV+HDV infection?

A. Coinfection of HBV and HDV rarely results in clearance of both viruses in the majority of cases.

B. Coinfection of HBV and HDV cannot result in acute liver failure.

C. HDV superinfections of HBsAg-positive patients lead to chronic HDV infection in the majority of cases and often have an aggressive course.

D. HDV superinfections of HBsAg-positive patients lead to chronic HDV infection in 40%-50% of cases.

E. Chronic HDV infection has always an aggressive course.

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